Provider Demographics
NPI:1427192749
Name:RIZZO, ROSARIO MICHAEL JR (LPN)
Entity Type:Individual
Prefix:
First Name:ROSARIO
Middle Name:MICHAEL
Last Name:RIZZO
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2239 S WOODLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-8633
Mailing Address - Country:US
Mailing Address - Phone:386-279-0151
Mailing Address - Fax:386-279-0148
Practice Address - Street 1:2239 S WOODLAND BLVD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-8633
Practice Address - Country:US
Practice Address - Phone:386-279-0151
Practice Address - Fax:386-279-0148
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN9044261164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL761368700Medicaid
FLPN9044261OtherNURSING LICENSE